Attorney General Eric Holder and Health and Human Services (HHS)
Secretary Kathleen Sebelius announced today that a nationwide takedown
by Medicare Fraud Strike Force operations in seven cities has resulted
in charges against 107 individuals, including doctors, nurses, and other
licensed medical professionals, for their alleged participation in
Medicare fraud schemes involving approximately $452 million in false
billing.

This coordinated takedown involved the highest amount of false Medicare
billings in a single takedown in strike force history.

HHS also suspended or took other administrative action against 52
providers following a data-driven analysis and credible allegations of
fraud. The new health care law, the Affordable Care Act, significantly
increased HHS’s ability to suspend payments until an investigation is
complete.

The joint Department of Justice and HHS Medicare Fraud Strike Force is a
multi-agency team of federal, state, and local investigators designed to
combat Medicare fraud through the use of Medicare data analysis
techniques. More than 500 law enforcement agents from the FBI, HHS-Office
of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units,
and other state and local law enforcement agencies participated in the
takedown. In addition to making arrests, agents also executed 20 search
warrants in connection with ongoing strike force investigations.

“The results we are announcing today are at the heart of an
administration-wide commitment to protecting American taxpayers from
health care fraud, which can drive up costs and threaten the strength
and integrity of our health care system,” said Attorney General Holder.
“We are determined to bring to justice those who violate our laws and
defraud the Medicare program for personal gain. As today’s takedown
reflects, our ongoing fight against health care fraud has never been
more coordinated and effective.”

“Today’s
arrests send a strong message to criminals that the consequences of
committing Medicare fraud are serious,” said HHS Secretary Sebelius. “In
addition to these arrests, we used new authority from the health care
law to stop all future payments to 52 health care providers suspected of
fraud before they are ever made. Today’s actions are another example of
how the Affordable Care Act is helping the Obama Administration fight
fraud and strengthen the Medicare program.”

The defendants charged are accused of various health care fraud-related
crimes, including conspiracy to commit health care fraud, health care
fraud, violations of the anti-kickback statutes and money laundering.
The charges are based on a variety of alleged fraud schemes involving
various medical treatments and services such as home health care, mental
health services, psychotherapy, physical and occupational therapy,
durable medical equipment (DME), and ambulance services.

According to court documents, the defendants allegedly participated in
schemes to submit claims to Medicare for treatments that were medically
unnecessary and oftentimes never provided. In many cases, court
documents allege that patient recruiters, Medicare beneficiaries and
other co-conspirators were paid cash kickbacks in return for supplying
beneficiary information to providers, so that the providers could submit
fraudulent billing to Medicare for services that were medically
unnecessary or never provided. Collectively, the doctors, nurses,
licensed medical professionals, health care company owners, and others
charged are accused of conspiring to submit a total of approximately
$452 million in fraudulent billing.

“As charged in the indictments, these fraud schemes were committed by
people up and down the chain of healthcare providers,” said Assistant
Attorney General Breuer. “Today’s operations mark the fourth in a series
of historic Medicare fraud takedowns over the past two years. These
indictments remind us that Medicare is an attractive target for
criminals. But it should also remind those criminals that they risk
prosecution and prison time every time they submit a false claim.”

“Health care fraud is not a victimless crime,” said FBI Deputy Director
Joyce. “Every person who pays for health care benefits, every business
that pays higher insurance costs to cover their employees, every
taxpayer who funds Medicare—all are victims. The FBI will continue to
work closely with our federal, state, and local law enforcement partners
to address health care vulnerabilities, fraud and abuse. We will use
every tool we have to ensure our health care dollars are used to care
for the sick—not to line the pockets of criminals.”

“Today over 200 OIG special agents, forensic examiners, and analysts
have deployed throughout the country to ensure that those responsible
for committing Medicare fraud are held accountable,” said HHS-OIG Deputy
Inspector General Cantrell. “OIG is committed to the strike force model
and will continue to use advanced data analytics along with traditional
investigative methods to root out those who steal from our Medicare
program.”

In Miami, a total of 59 defendants, including three nurses and two
therapists, were charged today and yesterday for their participation in
various fraud schemes involving a total of $137 million in false
billings for home health care, mental health services, occupational and
physical therapy, DME and HIV infusion. Two of these 59 defendants were
originally charged in April 2012 but were indicted on additional charges
today. In one case, 10 defendants were charged for participating in a
fraud scheme at Health Care Solutions Network, which led to
approximately $63 million in fraudulent billing for community mental
health center (CMHC) services. Court documents allege that therapists at
Health Care Solutions Network were instructed to alter notes and other
medical documents to justify CMHC services for beneficiaries who did not
need the services.

Seven individuals were charged today in Baton Rouge, Louisiana for
participating in a fraud scheme involving $225 million in false claims
for CMHC services. The case represents the largest CMHC-related scheme
ever prosecuted by the Medicare Fraud Strike Force. According to court
documents, the defendants recruited beneficiaries from nursing homes and
homeless shelters, some of whom were drug addicted or mentally ill, and
provided them with no services or medically inappropriate services.

In Houston, nine individuals, including one doctor and one nurse, were
charged today with fraud schemes involving a total of $16.4 million in
false billings for home health care and ambulance services. According to
court documents, the owners and operators of four different ambulance
companies billed Medicare for ambulance rides that were medically
unnecessary.

Eight defendants, including two doctors, were charged in Los Angeles for
their roles in schemes to defraud Medicare of approximately $14 million.
In one case, two individuals allegedly billed Medicare for more than $8
million in fraudulent billing for DME.

In Detroit, 22 defendants, including four licensed social workers, were
charged for their roles in fraud schemes involving approximately $58
million in false claims for medically unnecessary services, including
home health, psychotherapy, and infusion therapy.

In Tampa, Florida, a pharmacist was charged with illegal diversion of
controlled substances. One defendant was charged last week in Chicago
for his alleged role in a scheme to submit approximately $1 million in
false billing to Medicare for psychotherapy services.

The Medicare Fraud Strike
Force operations are part of the Health Care Fraud Prevention &
Enforcement Action Team (HEAT), a joint initiative announced in May 2009
between the Department of Justice and HHS to focus their efforts to
prevent and deter fraud and enforce current anti-fraud laws around the
country.

Since their inception in March 2007, strike force operations in nine
locations have charged more than 1,330 defendants who collectively have
falsely billed the Medicare program for more than $4 billion. In
addition, the HHS Centers for Medicare and Medicaid Services, working in
conjunction with the HHS-OIG, are taking steps to increase
accountability and decrease the presence of fraudulent providers.

The cases announced today are being prosecuted and investigated by
Medicare Fraud Strike Force teams comprised of attorneys from the Fraud
Section of the Justice Department’s Criminal Division and from the U.S.
Attorneys’ Offices for the Southern District of Florida, the Eastern
District of Michigan, the Southern District of Texas, the Central
District of California, the Middle District of Louisiana, the Northern
District of Illinois, and the Middle District of Florida, and agents
from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.